Effect of positive end-expiratory pressure on gastric insufflation during induction of anaesthesia when using pressure-controlled ventilation via a face mask: A randomised controlled trial

BACKGROUND Face mask ventilation (FMV) during induction of anaesthesia is associated with risk of gastric insufflation that may lead to gastric regurgitation and pulmonary aspiration. A continuous positive airway pressure (CPAP) has been shown to reduce gastric regurgitation. We therefore hypothesised that CPAP followed by FMV with positive end-expiratory pressure (PEEP) during induction of anaesthesia would reduce the risk of gastric insufflation. OBJECTIVE The primary aim was to compare the incidence of gastric insufflation during FMV with a fixed PEEP level or zero PEEP (ZEEP) after anaesthesia induction. A secondary aim was to investigate the effects of FMV with or without PEEP on upper oesophageal sphincter (UES), oesophageal body and lower oesophageal sphincter (LES) pressures. DESIGN A randomised controlled trial. SETTING Single centre, Department of Anaesthesia and Intensive Care, Örebro University Hospital, Sweden. PARTICIPANTS Thirty healthy volunteers. INTERVENTIONS Pre-oxygenation without or with CPAP 10 cmH2O, followed by pressure-controlled FMV with either ZEEP or PEEP 10 cmH2O after anaesthesia induction. MAIN OUTCOME MEASURES A combined impedance/manometry catheter was used to detect the presence of gas and to measure oesophageal pressures. The primary outcome measure was the cumulative incidence of gastric insufflation, defined as a sudden anterograde increase in impedance of more than 1 kΩ over the LES. Secondary outcome ...
Source: European Journal of Anaesthesiology - Category: Anesthesiology Tags: Ventilation Source Type: research

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ConclusionThere is no need to alter the dosage of oral anticoagulants prior to dental extractions provided the INR is within the therapeutic range of 2.0 –4.0, extractions are done in least traumatic manner and local measures are used to control postoperative hemorrhage, thereby reducing the risk of thromboembolic episodes in these patients.
Source: Journal of Maxillofacial and Oral Surgery - Category: ENT & OMF Source Type: research
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Source: Journal of Maxillofacial and Oral Surgery - Category: ENT & OMF Source Type: research
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Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Anesthesiology Source Type: forums
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Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Anesthesiology Positions Source Type: forums
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